Julia Arebro

Introduction: Risk factors for unsuccessful healing of a tympanic membrane perforation following myringoplasty lack consensus. Large cohort studies are missing. Methods: Data were collected for myringoplasties (with/without concomitant ossiculoplasty) performed the years 2014–2019 with a follow‐up visit using the Swedish Quality Register for Ear Surgery (SwedEar). Risk factors for unsuccessful surgical outcome, defined as non‐healed tympanic membrane at follow‐up, were calculated using logistic regression. Results: The study population included 3622 cases and 12.8% had a non‐healed tympanic membrane at follow‐up. The most commonly used graft material was fascia, used in 94.6% of the cases. Of the analysed variables, prior ear surgery (adjusted (a)OR 1.43, p = 0.005), age younger than 8 years (aOR 1.73, p = 0.015), a postoperative infection within 6 weeks after surgery (aOR 1.92, p < 0.001) and the surgical aim of achieving a dry/infection free ear (aOR 1.53, p = 0.045) were predictors for unsuccessful healing. For simultaneous ossiculoplasty at surgery, there was a significantly higher chance of having a healed tympanic membrane (aOR 1.49, p = 0.016). For other variables such as gender, operated side, season, graft material, perioperative antibiotics and infection free status at surgery, there was no significant effect on tympanic membrane healing. Conclusion: The present evaluation of the surgical results in SwedEar constitutes one of the largest studies on myringoplasty outcome. The results showed that the age of the patient, surgical aim, prior ear surgery and postoperative infection constituted risk factors for unsuccessful healing after myringoplasty. Surprisingly, ears requiring a concomitant ossiculoplasty had a higher healing rate.

Objective: An indolent form of mastoiditis has gained increased attention lately, challenging clinicians both regarding diagnosis as well as treatment. The etiology behind this assumed infection herein named subacute mastoiditis (SAM) is unknown; however, a link to nontuberculous mycobacteria (NTM) infections has been seen. A survey on pediatric cases with SAM over 20 years was performed to investigate the typical clinical features and to identify optimal treatment strategies for this condition, causing aggressive temporal bone destructions along with intratemporal and intracranial complications.Methods: A retrospective survey of pediatric patients (0–17 years) hospitalized with SAM during 2003–2023 at Karolinska University Hospital, Sweden, was conducted. Data collection included demographics, diagnostics (radiology, microbiology, histopathology), treatment, and clinical outcome.Results: Sixteen cases (median age 7.5 years) with SAM were included. Longstanding otorrhea from ventilation tubes preceded clinical signs of mastoiditis in most cases. CT scan generally revealed cortical temporal bone destructions close to the ear canal and sigmoid sinus. Histopathological examination displayed a high incidence of granulomatous inflammation. Upon microbiological testing, six cases revealed NTM infection. All cases underwent mastoidectomy, and 11 cases received long‐term mycobacteria‐targeted antibiotics. No deaths occurred, but seven cases had a delayed recovery or relapsing disease, and several cases experienced complications. The long‐term outcomes were good. Two cases with Mycobacterium tuberculosis mastoiditis were identified, entailing diagnostic challenges.Conclusion: Histopathological and microbiological sampling along with CT scan is crucial in diagnosing SAM. We suggest surgical intervention combined with empirical long‐term antimycobacterial treatment for optimal recovery and outcome in SAM.Level of Evidence: 4

Key Clinical Message: Acute onset of vertigo and hearing loss is rare in leukemic disorders. MRI can diagnose intracochlear hemorrhage as the underlying cause. The hearing can improve but if severe hearing loss preserves, cochlear implantation can be considered.

Oral squamous cell carcinoma (OSCC) remains an understudied and significant global cancer killer and dismal survival rates have not changed in decades. A better understanding of the molecular basis of OSCC progression and metastasis is needed to develop new approaches for treating this disease. The supportive network surrounding cancer tumor cells known as the tumor microenvironment (TME) has gained increasing interest lately since it performs essential protumorigenic functions. Cancer-associated fibroblasts (CAFs) are one of the main cell types in the TME and are known to play a key role in influencing the biological behavior of tumors. CAFs present a heterogeneity both in phenotype as well as functions, leading to the suggestion of different CAF subtypes in several cancer forms. The task to subtype CAFs in OSCC has, however, just begun, and there is today no united way of subtyping CAFs in this disease. This review aims to define the features of CAFs and to summarize CAF subtype research in malignancy with focus on OSCC including aspects as disease prognosis and therapeutic opportunities.

Oral squamous cell carcinoma (OSCC) remains an under-studied and significant global cancer killer and dismal survival rates have not changed in decades. A better understanding of the molecular basis of OSCC progression and metastasis is needed to develop new approaches for treating this disease. The supportive network surrounding cancer tumor cells known as the tumor microenvironment (TME) has gained increasing interest lately since it performs essential pro-tumorigenic functions. Cancer-associated fibroblasts (CAFs) are one of the main cell types in the TME and are known to play a key role in influencing the biological behavior of tumors. CAFs present a heterogeneity both in phenotype as well as functions, leading to the suggestion of different CAF subtypes in several cancer forms. The task to subtype CAFs in OSCC has however just begun and there is today no united way of subtyping CAFs in this disease. This review aims to define the features of CAFs and to summarize CAF subtype research in OSCC including aspects as disease prognosis and therapeutic opportunities.

Introduction: Oral squamous cell carcinoma (OSCC) is the most common form of head and neck cancer and has a survival rate of ∼50% over 5 years. New treatment strategies are sorely needed to improve survival rates—and a better understanding of the mechanisms underlying tumorigenesis is needed to develop these strategies. The role of the tumor microenvironment (TME) has increasingly been identified as crucial in tumor progression and metastasis. One of the main constituents of the TME, cancer-associated fibroblasts (CAFs), plays a key role in influencing the biological behavior of tumors. Multiple mechanisms contribute to CAF activation, such as TGFβ signaling, but the role of extracellular vesicles (EVs) in CAF activation in OSCC is poorly understood. Assessing the impact of oral cancer-derived EVs on CAF activation will help to better illuminate OSCC pathophysiology and may drive development of novel treatments options.Methods: EVs were isolated from OSCC cell lines (Cal 27, SCC-9, SCC-25) using differential centrifugation. Nanoparticle tracking analysis was used for EV characterization, and Western blot to confirm the presence of EV protein markers. Oral fibroblasts were co-cultured with enriched EVs, TGFβ, or PBS over 72 h to assess activation. Flow cytometry was used to evaluate CAF markers. RNA collected from fibroblasts was extracted and the transcriptome was sequenced. Conditioned media from the co-cultures was evaluated with cytokine array profiling.Results: OSCC-derived EVs can activate oral fibroblasts into CAFs that are different from those activated by TGFβ, suggesting different mechanisms of activation and different functional properties. Gene set enrichment analysis showed several upregulated inflammatory pathways in those CAFs exposed to OSCC-derived EVs. Marker genes for inflammatory CAF subtypes were also upregulated, but not in CAFs activated by TGFβ. Finally, cytokine array analysis on secreted proteins revealed elevated levels of several pro-inflammatory cytokines from EV-activated CAFs, for instance IL-8 and CXCL5.Discussion: Our results reveal the ability of OSCC-derived EVs to activate fibroblasts into CAFs. These CAFs seem to have unique properties, differing from TGFβ-activated CAFs. Gaining an understanding of the interplay between EVs and stromal cells such as CAFs could lead to further insights into OSCC tumorigenesis and potential novel therapeutics.

Postsurgical pyoderma gangrenosum (PSPG) develops in the skin after surgery without known cause. Immunosuppression constitutes first‐line therapy and increases the likelihood of successful surgery when needed. PSPG should be considered when a flap necrosis occurs.